Directives – Appendices and Forms

Please click on the title (below) to view the appropriate Appendix.

Appendix 1: Implementer Approval Form (all)

Appendix 2: Authorizer Approval For (all)

Appendix 3: Assessment of Competency (003,015)

Appendix 4: Performed Controlled Acts and Procedures (CAPs) (003,015)

Appendix 5: Oral and Injectable Non-insulin Antihyperglycemic Agents- Diabetes (003,015)

Appendix 6: Prescription of Diabetic Supplies and Performance of Capillary Blood Glucose Monitoring at Point of Care (003,015)

Appendix 7: Anaphylaxis Management

Appendix 8: Implementer Readiness Approval Form (All)

Appendix 9: Insulin Management (003)

Appendix 10: Laboratory Tests in Adults with Diabetes (003)

Appendix 11: Order Treatment Table for Pharyngitis in Adults (013)

Appendix 12: Order Treatment Table for Pharyngitis in Children 3-14 yo (014)

Appendix 13: List of Medications for Smoking Cessation with Detailed Indications/Contraindications (015)

Appendix 14: The Fagerstrom Test for Nicotine Dependence (015,022)

Appendix 15: Nicotine Replacement Dosing Information (015,022)

Appendix 16: Decision Tree to Address Nicotine Withdrawal: Increasing Dosage Beyond 21mg Patch (015,022)

Appendix 17: Interpretation of a TB Skin Test (017)

Appendix 18: Order Treatment Table for Lower Uncomplicated UTI (018)

Appendix 18.1: Assessment Tool UTI (018)

Appendix 19: Warfarin Dosage Adjustment Algorithm (020)

Appendix 20: Self Directed Learning Package (020)

Appendix 21: ATS Standardization of Lung Function Testing (023)

Appendix 22: Ontario Cervical Cancer Screening Guidelines (024)

Appendix 23: Detailed Well Woman History and Exam (024)

Appendix 24: Collection of Specimen (024)

Appendix 25: How to Perform Post-Bronchodilator Testing (023)

Appendix 26: Further Testing after Spirometry (023)

Appendix 27: Initiating Treatment for Asthma and COPD (023)